Ayurvedic management of diabetic peripheral neuropathy assessed by vibrotherm (the neuropathy analyser): a case report

Rejeesh Skaria; T. C. Marikutty

doi:10.18203/2320-6012.ijrms20263563

Authors

Rejeesh Skaria Department of Kayachikitsa, Vaidyaratnam Ayurveda College, Ollur, Thrissur, Kerela, India
T. C. Marikutty Department of Kayachikitsa, Vaidyaratnam Ayurveda College, Ollur, Thrissur, Kerela, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263563

Keywords:

Diabetes mellitus, Diabetic peripheral neuropathy, Vibrotherm, Prameha upadrava

Abstract

Diabetic peripheral neuropathy (DPN) is the most prevalent type of diabetic neuropathy and is a major complication associated with diabetes mellitus. Chronic hyperglycaemia, plays a major role in the development of diabetic neuropathy leads to cellular injury through multiple mechanisms. This is a case of 58-years-old female who consulted in Kayachikitsa OPD of Vaidyaratnam Ayurveda College Hospital on 12 August 25 presented with progressively worsening Numbness, Pain, Tingling and burning sensation in both feet for 2 years. She has been diagnosed with a case of DPN (Prameha Upadrava) based on clinical findings, neurological examinations and presence of impairment of Vibration perception threshold and hot perception threshold. Treated with Sundibaladi kashayam 48 ml twice daily along with 6 gms of Nisha amalaki choornam, Nishakatakadi kashayam as toya kashayam for frequent use, Pramehaushadi tablet 1 tablet twice daily after food and Pada abhyanga with Sahacharadi tailam externally for a period of 90 days. The patient was assessed with HbA1c level, vibration and thermal perception threshold test by neuropathy analyser Vibrotherm, toronto clinical neuropathy score (TCNS) and monofilament test on 0th day and 91th day of treatment. Significant improvements were observed in parameters like Vibration perception threshold (VPT), Cold perception threshold (CPT) and hot perception threshold (HPT) and TCNS score following the treatment. It suggests that internal administration of ayurvedic medicaments based on principles of Prameha chikitsa and Prameha upadrava chikitsa is effective in relieving the symptoms of DPN.

References

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 21st ed. Vol. 1. Chapter 405. New York, NY: McGraw-Hill; 2022: 3124

Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep. 2019;19(10):86.

Lee CM, Chang CC, Pan MY, Chang CF, Chen MY. Insufficient early detection of peripheral neurovasculopathy and associated factors in rural diabetes residents of Taiwan: a cross-sectional study. BMC Endocr Disord.. 2014;14:89.

Eid SA, Rumora AE, Beirowski B, Bennett DL, Hur J, Savelieff MG, et al. New perspectives in diabetic neuropathy. Neuron. 2023;111(17):2623-41.

den Braber N, Vollenbroek-Hutten MMR, Westerik KM, Bakker SJL, Navis G, van Beijnum BJF, et al. Glucose regulation beyond HbA1c in type 2 diabetes treated with insulin: real-world evidence from the DIALECT-2 cohort. Diabetes Care. 2021;44(10):2238-44.

Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):41.

Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron. 2006;52(1):77-92.

Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A; KORA Study Group. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10(2):393-400.

Pop-Busui R, Boulton AJM, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.

Vāgbhaṭa. Aṣṭāṅga Hṛdaya of Vāgbhaṭa, Nidānasthāna, Chapter 10, Verse 20. Varanasi: Chaukhambha Prakashan; 2016: 347.

Agniveśa. Caraka Saṃhitā, Cikitsāsthāna, Prameha Cikitsā Adhyāya, Chapter 6, Verse 17. Revised by Caraka and Dṛḍhabala; edited by Yādavaji Trikamji Ācārya. Varanasi: Chaukhambha Surbharati Prakashan. Available at: https://archive.org/search?. Accessed on 1 July 2026.

Ziegler D, Mayer P, Gries FA. Evaluation of thermal, pain, and vibration sensation thresholds in newly diagnosed type 1 diabetic patients. J Neurol Neurosurg Psychiatry. 1988;51(11):1420-4

Yuvaraj P, Paul AS, Varghese J, Jolly CI. Beneficial effect of Nishaakathakaadhi Kashayam on streptozotocin induced diabetes and glucose metabolic enzymes. Int J Ayurv Pharma Res. 2017;5(7):33-40.

Meng B, Li J, Cao H. Antioxidant and anti-inflammatory activities of curcumin on diabetes mellitus and its complications. Curr Pharm Des. 2013;19(11):2101-13.

Akhtar MS, Ramzan A, Ali A, Ahmad M. Effect of Amla fruit (Emblica officinalis Gaertn.) on blood glucose and lipid profile of normal subjects and type 2 diabetic patients. Int J Food Sci Nutr. 2011;62(6):609-16.

Bhāvamiśra. Bhāvaprakāśa Nighaṇṭu. Chunekar KC, Pandey GS, editors. Guḍūcyādi Varga. Varanasi: Chaukhambha Bharati Academy. Available at: https://archive.org/search. Accessed on 1 July 2026.

Dhalwal K, Deshpande YS, Purohit AP, Kadam SS. Evaluation of the Antioxidant Activity of Sida cordifolia. Pharmaceut Biol. 2005;43(9):754-61..

The Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122(8):561-8.

Vincent AM, Russell JW, Low P, Feldman EL. Oxidative stress in the pathogenesis of diabetic neuropathy. Endocr Rev. 2004;25(4):612-28. doi:10.1210/er.2003-0019.

Menon A. Ayurvedic management of diabetic peripheral neuropathy: A clinical case study. J Ayurv Integrat Med. 2025.

Patel H, Tank N. Panchakarma management of diabetic peripheral neuropathy: a case report. J Ayurveda Integr Med Sci. 2025;10(9):331-6.

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-86.

Sharma RK, Dash B. Caraka Saṃhitā of Agniveśa: Based on Chakrapāṇi Datta's Āyurveda Dīpikā. Reprint ed. Vol. 4. Varanasi: Chowkhamba Sanskrit Series Office; 2005: 275.